Related Experiment Videos
Results, potential effects, and implementation issues of the Resource-Based Relative Value Scale.
W C Hsiao1, P Braun, N L Kelly
1Department of Health Policy and Management, Harvard University School of Public Health, Boston, MA 02115.
JAMA
|October 28, 1988
Summary
The Resource-Based Relative Value Scale (RBRVS) study found significant shifts in healthcare payments. Evaluation and management services could see higher fees, while surgical services might face reductions under a budget-neutral RBRVS model.
Area of Science:
- Health Economics
- Medical Practice Management
- Healthcare Policy
Background:
- The Resource-Based Relative Value Scale (RBRVS) was developed to establish physician payment rates.
- Previous payment models did not adequately account for the resources required for different medical services.
Purpose of the Study:
- To present the overall results of the RBRVS study.
- To determine resource-based relative values for medical services across 18 specialties.
- To simulate the impact of an RBRVS-based fee schedule on Medicare payments.
Main Methods:
- Calculated resource-based relative values for selected services.
- Analyzed preservice, postservice, and intra-service work.
- Developed a model to simulate an RBRVS-based fee schedule under budget neutrality.
Main Results:
- Preservice and postservice work constitute a substantial portion of total work for invasive and evaluation/management services.
- Work intensity (work per unit time) is significantly higher for invasive services compared to evaluation/management.
- Simulations indicated potential fee increases for evaluation/management services (up to 70%) and decreases for surgical services (up to 60%).
- Medicare outlays in 1986 could have seen a 56% increase for evaluation/management services, with decreases for invasive, imaging, and laboratory services.
Conclusions:
- An RBRVS-based fee schedule could lead to substantial redistribution of Medicare payments.
- Implementation requires careful consideration of conversion factors, practice costs, billing codes, and potential impacts on healthcare cost and quality.